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Purpose: Gastroesophageal reflux disease (GERD) has been implicated as an etiology for a variety of pulmonary diseases and complaints. Traditionally, esophageal pH testing has been the gold-standard for evaluating GERD in these patients. However, patients with pulmonary disease may be affected by both acid and non-acid reflux and pH testing with impedance allows for the evaluation of these two entities. We aimed to evaluate the utility of pH testing with impedance for patients with pulmonary diseases and complaints.

Methods: The records of all patients with pulmonary complaints who were referred for pH testing with impedance to our motility laboratory between April of 2004 and May of 2005 at Mayo Clinic Jacksonville were reviewed. Patients' age, gender, pulmonary disease or complaint, medication use and pH testing with impedance were recorded. A pH test was considered abnormal if the esophageal acid contact time was greater than 4.6% of the total time tested. Non-acid reflux was diagnosed as >72 episodes of liquid reflux but with normal pH testing.

Results: There were 17 patients who had pH testing with impedance and pulmonary complaints. Overall, 10/17 (58%) had some evidence of reflux (acid or non-acid); 6/17 (35%) had non-acid reflux and negative pH testing; 4/17 had positive acid reflux (2 were off of acid suppressing medications and 2 were on twice daily proton-pump inhibitors). Of the 17 patients, six had IPF, five had COPD, three had chronic cough, one had cryptogenic restrictive bronchiolitis, one had asthma and one pulmonary hypertension. Only 2 patients were not on acid suppressing medications, and both of them had positive pH testing.

Conclusions: pH and impedance testing in patients with respiratory complaints is a useful tool to diagnose reflux in this population. This technique identified additional potential mechanisms (i.e. non-acid reflux) that may play an important role in the pathogenesis of respiratory symptoms in these subjects.

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